Having good systems is not enough. The three-year CareFirst pilot provided the standard Bridges to Excellence incentives to practices achieving various levels of National Committee for Quality Assurance, or NCQA, accreditation through the Physician Practice Connections, or PPC, program.
This program consists of nine modules, including the adoption and use of advanced electronic health records through various care-coordination activities for patients with chronic illness. Towers Perrins evaluation of the results determined that the accredited practices were not significantly differentiated on the basis of quality metrics (a set of Healthcare Effectiveness Data and Information Set, or HEDIS, measures) or care costs over the three-year pilot.
We concluded that the structural changes inherent in the PPC program (including the adoption of electronic tools), while necessary for change, were in themselves insufficient to result in improved care, and could be more appropriately viewed as a good starting point. Creating incentives closely linked to outcomes will more likely improve performance over the long term.
These findings are already being incorporated into new pay-for-quality programs under development by CareFirst.
Quality can be better and costs less. The results of the study of Bridges to Excellences pilot in Massachusetts show that practices that have adopted better systems and use those systems to monitor and manage their patients can deliver better results in cost and quality. On a series of standard claims-based HEDIS measures, the recognized practices scored higher than nonrecognized peers, with three of the five measures having differences that were significant. These practices also had lowered costs for every patient in their practice, not just patients with a chronic condition. And the difference was significant, reaching $360 per patient per year.
This halo effect of better care at a lower cost for all patients in the practice tells us that something different is going on in those practices than in their nonrecognized peers. While they dont have the official designation, they certainly have the characteristics that employers and health plans want to see in a medical home.
You need time and resources to make it work. The practices in these pilots took 18 to 24 months to progress along the transformation path, and the incentives required to get them to stick with the transformation effort were significant, ranging up to $300,000 for some of the practices. Of note, Bridges
to Excellences research shows a very tight relationship between the amount of incentives and the participation of physicians in these programs.
The practices made cash investments in systems and processes that would help them meet the criteria in the NCQAs PPC, and those investments would simply not have been made without the incentives. And the results of the Massachusetts and Washington-Maryland pilots show that structural changes in the practices have lasting effect, especially when the practices are subject to measurement of the results of the care they deliver.